Healthcare Provider Details

I. General information

NPI: 1407588627
Provider Name (Legal Business Name): AMBER MOTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N FORREST RD
PLAIN DEALING LA
71064-4031
US

IV. Provider business mailing address

PO BOX 792
VIVIAN LA
71082-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-326-7272
  • Fax: 318-326-7282
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226422
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number226422
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: